Obstetrics

Congratulations!
Basic Information During Pregnancy
OB Work Up Visit
What to Expect on Your New OB Work-up Visit
Your Responsibilities to Us
FAQ
Taking Care of Yourself Before, During and After Your Pregnancy
The Countdown to Delivery
Labor and Pre-labor
Common Concerns During Pregnancy
Do You Keep Thinking of More Questions?
Interesting Links

Congratulations!

Whether this is your first or your fifth it will be an exciting time filled with much anticipation. Included in this section of the website will be resources to help you during your pregnancy. We have provided information about our practice, childbirth classes, hospital tours, and many other pregnancy related topics. We encourage you to complete the Obstetrical Medical Questionnaire prior to your visit. It may then be faxed, mailed or simply brought to the first appointment.

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Basic Information during Pregnancy

Congratulations on your pregnancy!

We are glad that you have chosen us to take care of you during this very special time. Please feel free to ask any questions at any time. This information is provided to answer some commonly asked questions. If you need to inquire about starting prenatal vitamins or Folic Acid please call our office.

During pregnancy, you will usually be seen for regular visits every four weeks until 28 weeks, then every 2 weeks until 36 weeks and then weekly until delivery. You may either rotate amongst the providers or may see just one or two of them as you wish.

We do take turns being on-duty in the hospital, and when you are in labor or have a problem, the person on-call will take care of you. We deliver only at The Chester County Hospital and so we are always in attendance there.

There will be several routine tests done to assess the health of you and the baby. These include a standard blood pregnancy profile, Pap smear, and cultures at your first visit; blood tests for diabetes and anemia and in the third trimester; and a vaginal culture for Group B beta strep at 35-36 weeks. In addition we offer genetic screening including Cystic Fibrosis carrier status screening, Ashkenazi Jew (Tay-Sachs and other disorders more common in this group of individuals), First Trimester Screening for Down’s syndrome and a Quad Screen Testing (MAP) at 15-19 weeks to screen for Spina Bifida and Down's syndrome. Amniocentesis will be offered as needed for women 35 or over or for any woman who has other risk factors for genetic abnormalities. We offer everyone a routine screening ultrasound at 20-22 weeks. This test is not always covered by insurance. Please check with your plan. We encourage you to take care of yourself during the pregnancy; that means a balanced diet, regular exercise and an average weight gain of 20-35lbs.for women with an ideal pre-pregnancy weight. It also means no smoking or illegal drug use. No alcohol intake is the safest advice. If you have problems in any of these areas, we are happy to help you. Unfortunately, violence and abuse is all too common in women's lives, especially during pregnancy. Please bring this to our attention if it is a part of your life.

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OB Work Up Visit

Things you should bring for your first visit:

  1. A Completed Patient History
    You can find a printable, downloadable version by clicking here. By printing this form from your computer, you can complete it at your leisure before your first visit.
  2. A Completed HIPPA Notice of Privacy Practices
    You can find a printable, downloadable version by clicking here. By printing this form from your computer, you can complete it at your leisure before your first visit.
  3. A Completed Patient Information Sheet
    You can find a printable, downloadable version by clicking here. By printing this form from your computer, you can complete it at your leisure before your first visit.
  4. Your Current Insurance Card
    Please bring your insurance card with you on your first visit and keep us informed of any changes in your coverage. We will assist you in preparation of insurance claims for obstetrical and surgical services. We will need to make a copy of your original card for future visits.
  5. Your Insurance Provider's Preferred Lab
    As you progress through your pregnancy, we may need to order lab work. Having the name and number of the lab your insurance company uses will make things go smoothly down the line.
  6. Your Preferred Pharmacy
    As you progress through your pregnancy, we may need to write a prescription for you. Having the name and number of your preferred pharmacy will ensure a quick turnaround for your prescriptions.

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What to Expect on Your New OB Work-up Visit

We generally see Patients to confirm the pregnancy and ensure there are no problems, and address any special issues or concerns within a week of your request for an appointment, and sooner if you are experiencing any problems. We will at this initial visit give you a slip for necessary lab studies. It is important that you have these tests done prior to your next appointment. After this appointment we will ask you to schedule a New OB Work-up Visit, generally 4 weeks later.

It is very important to complete all of the forms prior to your first visit. If you do not have time to complete the downloadable forms, please arrive at least 15 minutes prior to your scheduled appointment time. It is also important to bring your current insurance information.

Even if this is not your first pregnancy, your first prenatal visit with one of our OB counseling nurses is still very important. It is during this meeting that we gather pertinent background information to save you time on your future prenatal visits as well as to order necessary tests based on your background information.

On your OB Work-up Visit, you will speak with one of our OB nurses. This is an exciting visit, introducing you to our office and allowing us the opportunity to learn about you and your expectations during your pregnancy. We'll also give you an idea of your due date and will provide you with lots of interesting material to make your pregnancy go as smoothly as possible. You will receive: diet information, and hospital policies.

Your OB Work-up visit is scheduled 8-10 weeks into your pregnancy. Your first prenatal visit with your doctor can be the same day if desired or will be scheduled for around week 10. Our Responsibilities to You

  • Provide high quality obstetrical care in a caring, comforting and attentive atmosphere.
  • Communicate with you openly about your pregnancy, including recommending additional testing or laboratory work that will help us in providing you the highest quality care.
  • Listen to your desires for your care and accommodate your wishes to the extent possible.
  • Return your phone calls within 48 hours.
  • Augment the education provided by Child Birth Education Classes regarding what to expect during pregnancy and at the time of delivery.
  • Let you know if we are running behind schedule. Each patient's circumstance is different. When you are with one of our doctors, please be assured that you have his or her undivided attention. However, sometimes this attentiveness puts the doctor behind schedule.

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Your Responsibilities to Us

  • Complete all your prenatal testing and laboratory work prior to your OB work-up visit. IT IS EXTREMELY IMPORTANT THAT YOU COMPLETE THIS LABORATORY TESTING IN A TIMELY MANNER, NO MATER HOW MANY TIMES YOU HAVE BEEN PREGNANT BEFORE.
  • Know if your insurance company requires a referral or other pre-authorization before we can provide care. Obtain any necessary referrals/authorizations before your visit.
  • When scheduling an appointment, tell us if you have specific problems to discuss or if you need to leave by a certain time. That way, we can allow enough time for your appointment.
  • Be flexible regarding which practitioner you see during your routine OB visits. We would like each patient to see all four of our practitioners at least once during your prenatal care. Arrive 15 minutes before your appointment time if you are a new patient or have any change in information (e.g. new insurance, change of address).
  • Try to bring your spouse/significant other and not to bring children to your pre-natal counseling visit with the nurse.
  • Call if you are going to be late for an appointment. Understand that if you are more than 20 minutes late, we may have to reschedule your appointment. You will be seen in order of when your appointment was scheduled, not by when you arrived. Some doctors may see patients faster than others. If a patient arrives after you, and is called first, it is because she is being seen by another provider.

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FAQ

Our Nurse Educator will provide you with more information and a book to help you plan and understand your pregnancy. This section is a general overview and may not apply to everyone.

Calling your physician
Please call if you have:

  • Blood or fluid coming from your vagina
  • Sudden or extreme swelling of your face or fingers
  • Headaches that are severe or won’t go away with Tylenol
  • Severe nausea and vomiting that won’t go away. “Severe” means vomiting numerous times during the day and being unable to keep any food or liquid in your stomach.
  • Dizziness
  • Dim or blurry vision
  • Pain or cramps in your lower abdomen
  • Chills or fever greater than 100.4° F
  • Pain, burning or urgency when you urinate. Urgency is when you feel as though you need to urinate, but are unable to do so, or can urinate only a little when you reach the bathroom.
  • Decreased fetal movement after you have begun to feel the baby move on a daily basis. Decreased movement is any change that you notice in the amount of the baby’s activity. Generally we expect that you should feel 10 movements in one hour’s time, but this varies from baby to baby.
  • Contractions before you reach your 37th week of pregnancy that occur 5-10 minutes apart and last for an hour and do not stop when you rest. Some women feel discomfort in their back; others feel menstrual-like cramping in their lower abdomen while some simply feel a tightening sensation spreading from their back and across their midline. Discomfort of contractions is intermittent, it comes and goes. During a contraction you will feel your uterus tighten up and harden.

Eating — what is the right amount?
What you eat feeds your baby, so choose healthy foods. You may need about 300 extra calories each day. Be sure to include the following:

  • 3 servings of milk or dairy products
  • 4 servings of vegetables
  • 3 servings of fruit
  • 9 servings of bread, cereals, rice, or pasta
  • 2 to 3 servings of meat, fish, poultry, dried beans, eggs or nuts
  • At least 6 to 8 glasses of water.

Exercise
Unless you have problems in your pregnancy, you can probably continue with whatever exercise you did prior to pregnancy. Walking and swimming are great choices. If you didn’t exercise before pregnancy, start slowly. It is probably best to avoid anything that could cause you to fall.

Morning Sickness
Nausea or vomiting may strike anytime during the day (or night). Try eating frequent, small meals, and avoid greasy foods. Keep crackers by your bed to eat before getting up. Talk to your doctor if this lasts past the first 3 months or causes you to lose weight.

Weight Gain
How much should I gain during pregnancy? Generally about 25 to 30 pounds. Depending on your initial weight, you may need to gain more than 25 to 30 pounds or gain only 15 to 18 pounds.

Medicines
DO NOT TAKE ANY MEDICATIONS DURING THE FIRST THREE MONTHS OF YOUR PREGNANCY WITHOUT YOUR DOCTOR’S PERMISSION!!!!! The first trimester is when the organs and body systems of your baby are forming. It is imperative that you do not ingest anything that may interfere with the process.

There are medications that you can safely take during pregnancy when used according to package recommendations:

  • Fever, Muscle Aches, Headaches & Backaches: Tylenol or Extra Strength Tylenol
  • Congestion, Runny Nose, Colds & Allergies: Actifed, Sudafed*, Chlortrimetron, Tylenol Cold, Benadryl, Vicks Inhaler
  • Coughs: Robitussin DM
  • Diarrhea: Kaopectate
  • Heartburn: Maalox, Mylanta, Tums, Pepcid or Zantac
  • Upset Stomach: Pepto Bismol
  • Constipation: Metamucil, Colace, Fibercon, Milk of Magnesia, Citrucel, Fiberall
  • Hemorrhoids: Preparation H, Tucks, Nupercainal, Anusol, under Hemorrhoid Proctocreme
  • Sore Throat: Chloraceptic Spray or Lozenges, Plain Sucrets
  • Sinus Infection/Ear Infection/Persistent Sore Throat, Etc.: If you are suffering from a persistent sore throat, or think you may have a sinus or ear infection, we suggest that you see your family doctor. If antibiotics are required to treat the infection and your family doctor is uncertain about the safety of a particular antibiotic in pregnancy, they may call our office. Many antibiotics are safe to take in pregnancy, though we prefer not to prescribe them unless medically necessary.

* Do not take if you are suffering from high blood pressure

Warnings and Things to Avoid

  • Do not smoke — it raises your risk for miscarriage, premature birth, low birth weight and many other problems.
  • Do not use drugs — cocaine, heroin and marijuana increase your risk of miscarriage, premature birth and birth defects. And your baby could be born addicted to the drug you have been using.
  • Do not drink alcohol — drinking alcohol during pregnancy is the major cause of preventable birth defects, including mental slowness.
  • Do not clean your cat’s litter box, or eat raw or undercooked red meat. You could get toxoplasmosis, a disease that can cause birth defects.
  • Do not sit in the sauna or hot tub. This raises your risk of miscarriage and birth defects.
  • Do not douche. Douching could force air into the vagina, which can cause an air embolism.

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Taking Care of Yourself Before, During and After Your Pregnancy

If you are planning a pregnancy, are already pregnant or are nursing, it is more important than ever that you take care of yourself. After all, it's not just you your body has to take care of now!

Eating Right
As a pregnant or nursing mom, your body becomes a productive machine, using what you eat as energy, thus the better the energy, the more efficient the machine works. Getting the best possible nutrition through what you eat each day (and taking your prenatal vitamins!) should be a priority for you. What you eat feeds your baby, so choose healthy foods.

You may need about 300 extra calories each day. Be sure to include the following:

  • 3 servings of milk or dairy products
  • servings of vegetables
  • 3 servings of fruit
  • 9 servings of bread, cereals, rice, or pasta
  • 2 to 3 servings of meat, fish, poultry, dried beans, eggs or nuts
  • At least 6 to 8 glasses of water

Morning Sickness
Morning Sickness, as the nausea many women feel during the first trimester is often called, can sometimes last even longer, possibly throughout the entire pregnancy. Changing your eating habits can help keep morning sickness at bay.

  • Eat six to eight meals a day, instead of three larger meals
  • Avoid hunger; it can increase nausea
  • Eat foods that are high in protein and carbohydrates. Eat plain, starchy foods, like toast, crackers, Melba toast, rice, noodles, dry cereal, etc. They are digested easily and less likely to cause nausea.
  • Drink plenty of fluids between meals. Concentrate your nutrients in them if you are not tolerating solids well. Drink milk shakes, pureed soups, fruit sorbets, sherbet, and cottage cheese with fruit or yogurt.
  • Do not drink while you eat. Separate solids from liquids by at least one hour.
  • Avoid fat, fried, spicy or rich foods. Eat very bland, simple foods.
  • Avoid the sight and smell of foods that make you queasy. Some women cannot tolerate food preparation in early pregnancy.
  • Some herbal teas have been recommended to help with nausea. Raspberry (also recommended as a general pregnancy tonic) and mint, peppermint, spearmint teas. Pennyroyal and grated fresh ginger tea are to be avoided.
  • Your prenatal vitamin is insurance for adequate nutrition. It is especially important if your daily intake is decreased related to nausea. Take your vitamin at the time of day when it will most likely stay down. Adequate nutrition is especially important to your baby during early pregnancy, as the organs are forming.
  • Physical and mental fatigue also may contribute to nausea. Listen to your body and get extra rest as needed.
  • Brush your teeth after vomiting to decrease nausea. You may need to use a child's toothbrush to prevent gagging.
  • If you are unable to keep anything down for 24 hours, be sure to call the office, because this will not correct itself and may be cause for concern.

If you have more questions about diet, nutrition and morning sickness, ask your doctor on your next visit.

The Importance of Exercise While You're Pregnant ... and After
Only your doctor can provide you with personalized advice as to the importance of exercise during your individual pregnancy. But experts agree that prenatal exercise can be beneficial for both mom and baby.

Women who exercise during pregnancy have:

  • less nausea
  • less tiredness
  • fewer backaches
  • fewer leg cramps
  • fewer swollen ankles
  • more strength and flexibility
  • more energy
  • better posture and circulation
  • more stamina for labor and childbirth
  • less stress

Women who exercise after giving birth:

  • add strength and muscle tone
  • have more energy to keep up with a new baby
  • return to pre-pregnancy shape faster than those who do not exercise

The Chester County Hospital Exercise Classes
Pre natal and post partum exercise classes are offered at the Center for Health and Fitness at The Chester County Hospital. For information and registration call (610) 436-8249.

Drink Your Water
Did you know your body is 98% water? Did you know that the amniotic fluid is 99% water? It's a pretty important substance and not one to be ignored. If you don't think you're drinking enough water, drink more.

The general rule is "drink to thirst." In other words, if you're thirsty, drink. Your doctor can give you a more personalized recommendation. Even if you're not thirsty, you should drink between 8 to 10 cups of liquid each day. That can come from water, fruit juice (mixed with ½ part of water), milk, Gatorade, Crystal Light or other non-caffeinated beverages and even foods. You may need more if you exercise and lose water through sweating.

Sex During Pregnancy
If you are concerned about whether you can continue with your normal sex life during pregnancy, WebMD provides many answers.

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The Countdown to Delivery

As your due date approaches, how will you know when it's time to call the doctor, grab your bag and head to the hospital? Not so fast! There's still so much to discuss!

As you get closer to delivering, there will be a few changes you will notice. First, your office visits will become more frequent. The visits will be scheduled every two weeks from 28 weeks until 36 weeks, when they will become weekly until your labor begins and you deliver. Although we have calculated your due date, your delivery may be different than that date.

We also will be performing one or more additional diagnostic tests during this time. Typically, between the 35th and 36th week of pregnancy, a Group B Strep test is performed to check for the presence of this common bacteria. If your test result is positive, we will treat you with an antibiotic during the labor process to make sure you don't pass Group B to your baby during delivery. Your doctor also may request additional tests.

Birthing Classes
Although not necessary, many women and families find it helpful to enroll in Birthing Classes. Not only do these classes help prepare you for the actual birth by teaching proven techniques for delivery, they also familiarize you and your family with the hospital and its procedures.

The Chester County Hospital offers a comprehensive Childbirth Education Program intended to meet the needs of first-time parents or experienced ones. They offer a wide variety of classes to help prepare the entire family in welcoming the newborn. The curriculum has been carefully designed to assist parents in obtaining the tools they will need for pregnancy, labor, birth, postpartum, breastfeeding, newborn care, parenting and sibling adjustment. Classes are taught by experienced maternal/infant nurse educators who have a special certification in childbirth education.

For more information or if you are interested in enrolling in the Birthing Classes at The Chester County Hospital; please visit www.cchosp.com or call 610-738-2300.

What to Pack
It's always a good idea to have a suitcase packed and ready to take to the hospital … just in case.

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Labor and Pre-labor

Premature Labor
Premature labor, also called preterm labor, is labor that starts before the completion of 36 weeks of pregnancy, or more than 3 weeks before your due date. Premature labor can often be stopped if you identify it early. Premature labor is related to 70% of infant deaths due to low birth weight. A low birth weight is defined as an infant weighing less than 5 lbs, 8oz or less at birth.

Warning Signs

  • Uterine Contractions — If you feel like your uterus tightening or the baby balling up for four times or more in one hour.
  • Menstrual-like Cramps — Cramps like those you may have during your period may come and go, or be constant.
  • Abdominal Cramps — These feel like stomach cramps with or without diarrhea.
  • Low Backache — This is a backache near your tailbone that comes and goes or is there constantly.
  • Pelvic Pressure — This feels like the baby is pushing down in your vagina.
  • Change in Vaginal Discharge — There may be a sudden change in your discharge. It may increase, or become more mucousy, watery or slightly bloody.

What to Do
If you have one or more of these warning signs, you could be in premature labor. You should:

  • Lie down
  • Drink 2-3 glasses of water
  • If the symptoms do not resolve in 1 hour, call your doctor immediately. Also call your doctor if you have any vaginal bleeding that is more than a light day of menstrual period or if you experience a sudden gush of fluid from your vagina.

Causes of Premature Labor
Experts do not really know the actual causes of premature labor, but some things that may put women at risk include:

  • Previous premature labor or delivery of a premature baby
  • Twin or triplet pregnancy
  • Medical problems, such as high blood pressure, diabetes, kidney or lung disease
  • Abnormality of the uterus or cervix
  • Abnormality of the placenta
  • Women under 17 years
  • DES exposure

The Labor Process
Things to Watch for in the Next Several Weeks:

  • Some swelling of the legs and feet is normal. Excessive swelling in the hands and face are not, and you should call our office immediately if you experience this. In addition, if you experience unusual headaches, you should call the office.
  • Sharp abdominal pain with bleeding or bright red bleeding is not normal and you must call the office immediately.
  • You may sense that your baby's movements have subdued somewhat, however, what is happening is that as the baby grows, there is less room for him or her to move. Be aware of the overall patterns of movements as you progress. Please call the office if you have concerns about these patterns.
  • A gush of fluid from the vagina or continuous leaking should be evaluated. If you experience either, please call the office.
  • The onset of labor – If you experience contractions that are regular and are no more than 5 minutes apart, please call the office.

Preparing for Labor
When you finally do go into labor, you may feel generalized pain from time to time. This is normal. If you are uncomfortable at times, you may do any of the following:

  • Sit in a warm bath
  • Have someone give you a lower back massage. Using common household items such as a tennis ball or a rolling pin can be effective.
  • Use ice, a heating pad, or a combination of both on your lower back.
  • Consume water, juice or even a Popsicle as a way of maintaining fluids.

By the time you go into labor, you will likely feel frequent contractions (sometimes referred to as Braxton-Hicks contractions). These are normal and are an indication that your body is preparing for actual labor. While the onset of labor is different for each woman, one or more of the following may occur as you begin to go into labor:

  1. You may begin to suffer persistent back pain. Many times the pain will be accompanied by a feeling similar to premenstrual cramps.
  2. The appearance of a mucous discharge. It might be slightly blood-tinged. This plug blocks the cervix and its passing indicates that labor could be imminent. Even if it's several days away, this indicates that things are moving in the right direction.
  3. You also may begin to suffer from diarrhea.

Is It Really Time?
At Associates for Womens Medicine, we recommend that patients call us when any or all of the following occur:

  1. Your water breaks, or if you are unsure if your water has broken.
  2. You are having contractions 5 minutes apart, or less, for more than 1 hour. Labor contractions generally last more than 60 seconds from start to end.
  3. You can't carry on normal conversation during the contraction.
  4. You are experiencing heavy vaginal bleeding.
  5. You notice a significant change in fetal movement patterns.

These are all signs of active labor and you should call our office and plan to proceed to the hospital immediately. But … always call us if you have concerns not listed above

Hospital Procedures
When you arrive at The Chester County Hospital, if it is during the day you will need to enter through the Admissions Office. During the night time hours you should enter through the Emergency Room entrance. The admission staff at the hospital will ensure that you are properly processed and admitted in a timely manner. If you are not pre-registered, please contact our office to identify the documents you will need upon admission to the hospital.

At the Hospital
Once you are admitted, and probably before your doctor sees you at the hospital, several things already will have occurred:

  • You will be placed on a fetal monitor so that your contractions and your baby's heart rate can be monitored.
  • A member of the hospital's labor and delivery team will do a vaginal exam to determine your dilation and effacement.
  • There are various forms of anesthesia or analgesics that may be offered to treat your labor pain. If you have elected to have an epidural, the labor and delivery nurse will coordinate with your physician (or the delivering OB) and the anesthesiologist to administer the epidural at the appropriate time. This may occur before you are seen by your physician, but not without the consent of your physician.

Visting
Father
10 AM – 10 PM if mom is sharing a room, otherwise 24 hour visitation.

Others
Siblings of the newborn, and other family members and friends are welcome to visit you during your stay. Children under 12 are not permitted unless they are a sibling. There is a maximum of 4 visitors at a time.

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Common Concerns During Pregnancy

This portion is provided to you as a guide and should not replace seeking medical attention if you have questions or concerns.

ALCOHOL
Don't drink any alcoholic beverages. It is a known fact that alcohol in excess can cause damage to your unborn child. Remember that alcohol is a drug and that any product that contains alcohol is a drug. There is NO safe amount of alcohol.

BATHING
Take tub baths or showers, whichever you prefer. Water generally does not enter the vagina during these activities, so chance of infection is minimal. Your balance may be more difficult to maintain toward the end of your pregnancy, so be careful while getting in and out of your bathtub and make sure it has a nonslip surface on the bottom.

BOWELS
Your regular bowel habits may become disturbed during your pregnancy. Hemorrhoids appear more frequently. These changes probably result from relaxation of the muscle cells in the bowel and pressure on the surface of the bowel wall from the expanding uterus containing the growing baby. Stool softening usually provides relief without danger to you or your baby. But don't take a laxative, enema, or any drug without consulting the doctor first. Avoid enemas. Some dietary changes can safely prevent constipation: increased quantities of bran, fresh and dried fruits, vegetables, water, and other fluids all help.

BREASTS & SKIN
Breasts enlarge during pregnancy because of hormonal changes. The nipple area becomes darker. Other parts of the skin may become discolored—the neck, face, and a line down the middle or lower part of the abdomen. These changes are temporary and normally disappear after delivery. Use a moistening lotion or cocoa butter around the abdomen and breasts to guard against stretch marks as much as possible. Use sunscreen on skin areas exposed to the sun.

CAFFEINE
Consumption of caffeine in low to moderate amounts is not associated with significant risks during pregnancy. Heavy caffeine use can result in potential problems such as low birth-weight. Heavy caffeine drinkers should reduce their caffeine use while pregnant. Other sources of caffeine besides coffee to be alert to are teas, sodas, chocolate and some nonprescription drugs.

CLOTHING & SHOES
• Maternity clothes are available in a wide range of prices and styles. In addition, some regular clothing with a loose fit can be worn during and after a pregnancy. Outer clothing should be practical and non constrictive. Because a pregnant woman may feel the cold less and perspire more, cotton and natural fibers may be more comfortable than synthetic fabrics. • Wear maternity pantyhose or special support hose. Regular pantyhose may constrict blood flow. Wear maternity bras that are well-fitting and give good support. • Shoes should be low or medium heeled and as comfortable as possible with nonskid soles. Swollen feet are common during pregnancy due to normal fluid retention. There may be extra fat in the feet if weight gain is excessive. The shoe size may increase.

COSMETICS & HAIR CARE PRODUCTS

  • There is no specific evidence that cosmetics and other personal care products (soaps, lotions, and deodorants) affect pregnancy outcomes. Use these products with caution.
  • Hair care products such as dyes, strengtheners, and permanent wave solutions have been studied in pregnant women and have not shown to have any specific risks. Exposure to these products should not pose a risk to the fetus. During pregnancy, hair reacts differently to a tint or permanent so it might be best to wait until after delivery. Hair care products such as sprays and shampoos carry no evidence that they do or don’t cause any adverse outcomes for a pregnancy. Most women continue to use their pre-pregnancy hair products and experience no problems.

DOUCHING
Don't douche.

EMPLOYMENT
• You may safely continue working throughout your pregnancy. • Some jobs that involve physical exertion may need evaluating by the doctor. There are no set guidelines regarding work during pregnancy as expectant mothers have differences in levels of capability, pre pregnancy conditioning, exercise tolerance and physique.

EXERCISE
Continue to enjoy fitness and recreational activities as you did before pregnancy if your doctor has given the go ahead. Some activities may need to be moderated if they are physically strenuous. Pregnancy is not the time to try a new sport or physical activity. Exercise classes designed for pregnant women are helpful. Avoid activities such as horseback riding, skydiving, motorcycle-racing, fast running, water-skiing and others that carry undue risks.

MEDICATIONS
DO NOT TAKE ANY MEDICATIONS DURING THE FIRST THREE MONTHS OF YOUR PREGNANCY WITHOUT YOUR DOCTOR’S PERMISSION!!! . This includes all prescription drugs, nonprescription drugs, vitamins, herbs, laxatives, cold remedies, simple pain remedies and others. For the sake of your unborn child as well as for your own welfare avoid completely marijuana, cocaine, tobacco, alcohol, narcotics, tranquilizers, sleeping pills, or any other mind-altering drugs. The safest course to follow during pregnancy is to take nothing except nutritious food and beverages.

The first trimester is when the organs and body systems of your baby are forming. It is imperative that you do not ingest anything that may interfere with the process. There are medications that you can safely take during pregnancy when used according to package recommendations:

  • Fever, Muscle Aches, Headaches & Backaches: Tylenol or Extra Strength Tylenol
  • Allergies: Claritin, Allegra and chlorpheniramine
  • Congestion, Runny Nose, Colds & Allergies: Actifed, Sudafed*, Chlortrimetron, Tylenol Cold, Benadryl, Vicks Inhaler
  • Coughs: Robitussin DM
  • Diarrhea: Kaopectate
  • Heartburn: Maalox, Mylanta, Tums, Pepcid or Zantac
  • Constipation: Metamucil, Colace, Fibercon, Milk of Magnesia, Citrucel, Fiberall
  • Yeast infection: Antifungal (Monistat, Gyne-Lotrimin, and Mycelex)
  • Hemorrhoids: Preparation H, Tucks, Nupercainal, Anusol, under Hemorrhoid Proctocreme
  • Sore Throat: Chloraceptic Spray or Lozenges, Plain Sucrets
  • Sinus Infection/Ear Infection/Persistent Sore Throat, Etc.: If you are suffering from a persistent sore throat, or think you may have a sinus or ear infection, we suggest that you see your family doctor. Antibiotics such as penicillin, cephalosporin, erythromycin, Bactrim, Macrodantin, and Zithromax are considered safe in pregnancy. If antibiotics are required to treat the infection and your family doctor is uncertain about the safety of a particular antibiotic in pregnancy, they may call our office. Many antibiotics are safe to take in pregnancy, though we prefer not to prescribe them unless medically necessary.

*Do not take if you are suffering from high blood pressure

The following substances seem to be safe throughout pregnancy:

  • NutraSweet
  • Sunscreen
  • Dental x-rays with abdominal shielding

PAINTS
Avoid painting and inhaling toxic fumes in confined areas. Medical studies on paint exposure and fetal harm are inconclusive. Oil-based paints and paint thinners contain different solvents that should be avoided, especially in the first trimester of pregnancy.

REST PERIODS
Include rest periods in your routine, several times a day for short periods. Lie on one side or the other during these rest periods, rather than flat on your back, because blood flow through the placenta may be decreased if you lie on your back.

SEAT BELT USE
The use of seat belts is recommended to decrease maternal and fetal trauma in the event of a motor vehicle accident. Use a diagonal shoulder strap and a lap belt. The diagonal strap should pass over the shoulder and across the chest between the breasts. The lap strap should lie across the upper thighs. The straps should be above and below the “bump” of pregnancy, not over it.

SEXUAL INTERCOURSE
Enjoy sexual intercourse as usual, as long as it is not uncomfortable. There may be restrictions on sexual intercourse in cases of pregnancy-related complications (e.g., placenta previa, preterm labor). These activities may lead to cramping or contractions.

SMOKING
There can now be no doubt that smoking is injurious not only to you but also (even more so) to your unborn child. So don't smoke! If you are a smoker and need help in stopping, speak to the doctor about methods, support groups, and so on.

TEETH
Pregnancy puts an extra strain on dental health. Be particularly careful about brushing and flossing during your pregnancy. Routine dental examinations, preventive and restorative procedures should be provided when necessary. Local anesthetics used for dental procedures are considered safe. If dental x-rays (or other kinds of x-rays) become necessary, make sure that your abdomen is shielded by a standard lead apron.

TRAVEL

  • If possible, plan your trip for the second trimester of pregnancy. The risk of miscarriage is greatest during the first trimester and, in the third trimester, early labor could begin.
  • Travel does not adversely affect pregnancy. Avoid sitting for many hours without getting up and moving around. Empty your bladder frequently so as to avoid an increased risk of bladder infections caused by retained urine. Don’t take any anti-nausea travel medications without the doctor’s approval. Carry a record of your medical history with you.
  • Avoid travel if you have a threatened miscarriage or a history of miscarriage. Avoid travel to areas at high altitudes or areas where certain vaccinations (that may be hazardous during pregnancy) would be necessary.

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Do You Keep Thinking of More Questions?

That's OK! These new body changes during pregnancy and nursing can be very confusing. At Associates for Women's Medicine, we understand! If you find that our links and searching the Internet haven't answered all of your questions, keep a notebook and write your questions in it. On your next obstetrical visit, bring your notebook and ask your doctor, or contact our office for a nurse to respond in a timely manner. We're happy to make you as comfortable as possible during your pregnancy.

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Interesting Links

American College of Obstetricians and Gynecologists
www.acog.com
This official Web site of the American College of Obstetricians and Gynecologists provides a physician directory, health columns, post-graduate courses and much more.

WebMD
www.webmd.com
This site offers a great amount of reliable health information

Up to Date
www.patients.uptodate.com
Up To Date is a tremendous source of information for healthcare providers and has a patient portal for non health care individuals to access health information.

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